... Soap Note on patient SM Patient initials: SM Sex: male Race: white Marital status: single Occupation: Student Source of information: the patient gives the information and he seems reliable. Problem Statement “I am here for a physical test on my right ankle. The ankle got sprained two days ago while I was playing soccer with some of my friends in the football pitch. One of them accidentally hit me. I did not make an earlier visit because I thought the effect was minimal and it would disappear after some time. The pain has been got worse over the last days and most especially during the night.” Subject HPI: A 22 white male came for a physical test on a sprained right ankle. The patient states that he is usually in good health. The patient denies case of diarrhea, and hemorrhoids. He denies instances of chest or abdominal pains. The patient denies instances of nausea. The patient claims that he has lost minimal weight over the past six months. Pertinent Medical Information Patient denies chronic medical conditions. The last exam for dental and eye were both done in year 2014. Current Medications OTC Ibuprofen, 200 mg PO prn ankle pain and Tylenol 1-4/month for headache. The patient should take no prescription medications, supplements or vitamins. The Cholesterol level is low according to 2014 test results. Allergies Patient states that he does not suffer any form of allergies. Preventive Issues Patient immunization...
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...wound on her right upper leg where a femoral-popliteal bypass graft was performed two weeks ago. She is diabetic and injured her left ankle by tripping on a curb on the way to the hospital. She is anxious about not being able to care for herself when she returns home. She lives alone but has a daughter close by, and has no insurance. This Simulated Clinical Experience™ (SCE™) has five states, that are transitioined manually. With manual transitions, the instructor should advance to the applicable state when appropriate interventions are performed. Initially, in State 1 0900 Hours Assessment, the learner is presented with a patient who is febrile and exhibiting other signs of infection. Initial assessment reveals a temperature of 38.6o Celsius, HR in the 80s, BP in the 140s/80s, RR in the low 20s and SpO2 in the mid 90s on room air. Breath sounds demonstrate crackles bilaterally. The patient is anxious and incontinent of urine. She has a non-productive cough and reports tenderness over the left ankle. Initial treatment includes application of an elastic bandage to the left ankle, assessment of pain level, administration of pain medications, insertion of a urinary catheter and a sterile wet-to-moist dressing change to the graft site. If learners request results of blood glucose, the facilitator should role-play the laboratory technician and report that admission blood glucose was 105. Two hours post admission at 1100, patient complains of “throbbing” pain at the graft site. She rates...
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...Therapy By: Corbin Felts By: Corbin Felts Communicating Effectively in the Field of Physical Therapy Communicating Effectively in the Field of Physical Therapy Injuries cannot be avoided in the world of competitive sports. Of course, when injuries occur, they must be treated. The significance and type of injury can vary but it is the physical therapist’s responsibility to insure quality treatment. The duties of a physical therapist include evaluating, diagnosing, and documenting the type of injury(s), as well as prescribing appropriate treatment. Writing in the field of physical therapy plays a key role to the success of a patient’s wellbeing as well as a physical therapist’s career. When giving your written diagnosis and treatment plans, the accuracy and articulation of your writing holds the key to either a speedy recovery or the risk of further injury. Physical therapists must stress the importance of being able to communicate with patients both orally and in writing. Injuries cannot be avoided in the world of competitive sports. Of course, when injuries occur, they must be treated. The significance and type of injury can vary but it is the physical therapist’s responsibility to insure quality treatment. The duties of a physical therapist include evaluating, diagnosing, and documenting the type of injury(s), as well as prescribing appropriate treatment. Writing in the field of physical therapy plays a key role to the success of a patient’s wellbeing as well as a physical...
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...head-on at a high rate of speed. Of his two passengers, one of them is a brother, all require 20 minutes of extrication time from the severely damaged vehicle. After freeing our patient, the team works together to assess and stabilize him. His initial vital signs are worrisome, with a BP of 140/80, pulse of 160 and spontaneous respiratory rate of 8. The nurse assumes his care and quickly supports his respiratory rate by bagging and suctioning blood from his airway then inserting an ET tube to ventilate through. A team of 2 EMT’s assist to immobilize him on a spine board, stiff-neck collar, and CID blocks. The patient responds only by flexing to pain, no eye opening or verbalization. His noted obvious injuries are large head laceration approx. 6 inches in length, a head injury with his decreased level of consciousness, left...
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...Pulmonary Problems Chapter 10 Pneumonia is inflammation of the lungs resulting in consolidation Obstruction in gas exchange on the alveolar level Aspiration most common cause 2nd most frequent cause is droplet inhalation Least likely cause is blood borne Protein rich fluid move into the alveoli- complicated by production of the organism- result is decreased alveolar surface area-resulting in elevation of pco2 and a decrease in po2 Inspection-tachypnea and central cyanosis Percussion-dullness Palpitation-tactile fremitus Auscultation-crackles, rhonchi, wheezing, or egophony Diagnosis-labs, chest xray Ct not recommended unless anthrax is suspected Bronch-immunocompromised individuals and patients who have not responded to treatment Xrays Focal- bacteria Interstitual-viral Rapid progression/ multifocal- legionella, pneumococci, staphylococci Medialstinal widening without infiltrates- inhalation anthrax Tamiflu within 48 hours to be effective HAP-received care in a health care institution for at least 2 days in the last 90 days prior to infection VAP- pneumonia within 48 hours of intubation HAP more difficult to treat compared to CAP COPD- include emphysema, chronic bronchitis, and small airway disease Emphysema-structural change via destruction and enlargement of alveoli Chronic bronchitis- chronic cough and mucous production Small airway disease-generalized narrowing of bronchioles, may include asthma COPD-4th leading cause of death in United States ...
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...Hyperlipidemia * HTN * BPH Surgeries * None Problems at Birth: Patient reports that she was a full term healthy baby; 7lbs 8oz. Denies any problems at birth. Childhood Illnesses: The patient reports having had chicken pox. Immunizations: Patient claims to be up to date on all immunizations. Last flu shot (Fall of 2014) He denies any international travel or related immunizations. Family Health History: None Social History/Health Maintenance Activities: A.A. is married and lives with his wife. Retired engineer. Inactive lifestyle. Has a daughter that lives in Kansas. * Tobacco * Quit smoking 10 years ago. 2 pk/day x 50 years * Alcohol * Patient reports no alcohol use. * Diet * Patient reports a “regular diet”, “orders take-out often and drinks 4-6 diet cokes each day. * Exercise * Patient reports no regular exercise. * Colon * Patient denies any colon problems. He reports having a “normal” BM once daily or every other day. * Dental * Patient reports annual dental appointments. No complaints. * Skin * A.A. reports no regular dermatology appointments. He reports wearing sunscreen with prolonged sun exposure. * Eyes * Patient claims to have “good” vision. He does not report wearing glasses/contacts. Reports having last eye appointment last year. * Safety * Patient reports wearing seatbelt when in an automobile and...
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...NCLEX Chapter 6 Q1. Nurse is talking to a Japanese American patient about his upcoming surgery. The patient keeps nodding and smiling. What does that mean? A1: The nodding and smiling is cultural/part patient’s culture. A2: Patient agrees with treatment. A3: Patient agrees that the procedure is required. A4: Patient understands the process of preoperative procedures. Correct answer is 1. Because answers 2 and 3 may not mean that patient agrees with the treatment, speaker, or understands the procedure. Option 4 falsely interprets patient’s behavior. Q2. What is the best thing to do when the nurse is talking to a patient of different language? A1: Talk slow and loud. A2: Get an interpreter. A3: Talk to the patient and family at once. A4: Talk loud while being close to the patient. Correct answer is 2. Answer 3 violates patient’s privacy rights, answers 1 and 4 are wrong because talking loud wouldn’t be therapeutic to the patient, but the opposite. Q3. The nurse educator is educating staff transcultural nursing, when a staff member asks to explain acculturation. What is the most appropriate response? A1: It is learning new culture and adapting to change. A2: It is importance of person’s heritage and a desire to belong. A3: It is a group of people that are culturally unique. A4: It is a group that shares characteristics of the population that it is a part of. Correct answer is 1 because the definition of acculturation means learning new culture and adapting...
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...Dietary Protein Increase and the Promotion of Wound Healing in Diabetic Adult Patients Dietary Protein Increase and the Promotion of Wound Healing in Diabetic Adult Patients Introduction There are approximately 23 million people diagnosed with diabetes in the U.S. (American Diabetes Association, 2012) and this population continues to grow. There are multiple complications associated with diabetes. One major and expensive complication is diabetic wounds. The cost of care in the U.S. alone for this population is approximately $245 Billion annually. (American Diabetes Association, 2012) Proper wound care is an essential step in the wound healing process, however,wound care alone is not sufficient. Nutritional status is extremely important in wound healing. Diabetic patients need to be educated and assessed for protein-energy malnutrition (PEM) as the body’s nutritional needs significantly increase during the wound healing process (Demling, 2009). Supplementation (especially protein) and the importance of it for wound healing need to be discussed with the patient. Without all the necessary interventions applied the process of wound healing can be lengthy and may lead to infection, excessive hospitalization and potential amputations. Understanding the body’s nutritional needs and how the body uses protein in the repair process is imperative. The recommendation for the amount of protein supplementation is between 0.8grams/kilogram to 1.2 grams/kilogram and is based on patient...
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...[pic] ICAK-USA Research The Following is a Compilation of Applied Kinesiology Research Papers Published in the Collected Papers of the International College of Applied Kinesiology for the year 2005-2006 -- Edited by Scott Cuthbert, D.C. Functional Systems Approach to Central Nervous System Evaluation Richard Belli, D.C., D.A.C.N.B. ABSTRACT Objective: This study investigates the clinical utility of testing functional systems within the central nervous system, compared to testing individual motor nerves with manual muscle testing. Design: Private practice. Study Subjects: Patients were examined by the treating chiropractor from his existing patient pool. Methods: Chiropractic management was decided on by the treating chiropractor. A series of twelve tests were designed to discover disorders of functional systems within the CNS. The tests described were to evaluate the function of 12 systems: 1) spinal cord, 2) myelencephalon/reticular formation, 3) vagal system, 4) trigeminal motor system-muscles of mastication, 5) vestibulospinal system, and bulbo reticular area, 6) reticular formation, 7) diencephalons and gait locomotion system, 8) mesencephalon, 9) cardiac sympathetic autonomic system, 10) pyramidal system, 11) limbic system, 12) sensory system. Results: This chiropractic approach tests the nervous system after provocation of functional systems...
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...Nursing Process Focus: Patients Receiving Phenelzine (Nardil) |Assessment |Potential Nursing Diagnoses | |Prior to administration: |Sorrow, Chronic related to | |Obtain complete medical history including allergies, neurological , |depressive state. | |cardiac, renal, biliary, and mental disorders including blood |Thought Processes, Disturbed related to | |studies: CBC, platelets and liver enzymes,. |effects of drug therapy | |Obtain patient’s drug history to determine possible drug interactions|Adjustment, Impaired related to inadequate | |and allergies |drug effectiveness. | |Obtain 24 hour dietary history to identify |Knowledge, Deficient, related to drug | |tyramine containing foods ingested |action and side effects. | |recently |Suicide, Risk for related to inadequate drug ...
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...experience, hikers expect it to be pleasant. Sometimes hikers can interfere with each others' enjoyment, or that of other users of the land, but they can minimize this interference by following good etiquette. For example: * When two groups of hikers meet on a steep trail, there may be contention for use of the trail. To avoid conflict, a custom has developed in some areas whereby the group moving uphill has the right-of-way. In other situations, the larger of the two groups will usually yield to the smaller. * Being forced to hike much faster or slower than one's natural pace can be annoying, and difficult to maintain consistently. More seriously, walking unnaturally fast dramatically increases fatigue and exhaustion, and may cause injury. If a group splits between fast and slow hikers, the slow hikers may be left behind or become lost. A common custom is to encourage the slowest hiker to hike in the lead and have everyone match that speed. Another custom is to have an experienced hiker sweep up the rear, to ensure that everyone in the group is safe and nobody straggles. * Hikers often enjoy the silence and solitude of their surroundings. Loud sounds, such as shouting or loud conversation, disrupt this enjoyment. Some hikers purposely avoid loud sounds, out of deference to other hikers. Staying quiet will also increase the likelihood of encountering wildlife. (This is a hazard if dangerous animals are present; see "Personal safety hazards".) * Hikers sometimes trespass...
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...“I am afraid that I might scrape it when I am putting my shirt on and off. It bothers my wife more than it does me.” BB denies having any other moles that he is concerned with. BB states that he hasn't had any other skin issues such as itching, pain, tingling or redness. BB does think that his skin is somewhat dry. BB states that he has had no skin problems other than a sunburn once in a while. He doesn't know of any allergies or skin reactions other than the normal skin reactions such as poison ivy. BB states that he doesn't notice any significant hair loss. He has not noticed any changes in his nails or nail beds. BB denies any issues with body odor. Past History: BB states that he has never had neck or head injuries. He has never had surgery on his...
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...History and Physical Assessment: a. Biographical Data: A.G. is a 56 year old Hispanic male who is married with three children. All three children are young adults and living at home. He completed the sophomore year of high school, and works in the fields. Patient can communicate efficiently in English, but more articulate in Spanish. He is insured by Blue Cross. The patient’s primary diagnosis is ascending colon polyp. The operative procedure is DaVinci assisted Laparoscopic right colon resection possible ostomy. Patient was able to answer most of the questions. His wife translated whatever needed more explanation. Client’s Current Health Status b. Chief Complaint: Patient stated his chief complaint was that the doctor advised surgical removal of a polyp. “I went to the doctor because of my age {56} for a colonoscopy and the doctor said I had 3 polyps. The doctor got the other two polyps but said he must cut out the polyp or it will rupture in the colon” c. Presenting Symptoms: No apparent evidence of pain. The onset of his diagnosis began when A.G. was having a diagnostic test done. A.G. went to the doctor on January 23 for a routine colonoscopy and found out during the test that the third polyp was too big, but benign. A.G. states “The location of the polyp was in the right side. It is localized in a small area, a couple of inches of the bowel” A.G. states he feels no pain. Due to the location of the bowel, there are no signs or symptoms that A...
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...prolonged and unfair wait times at Veterans Health Administration (VHA) facilities that led to potentially preventable morbidity and mortality. In response to this, the Institute of Medicine (IOM) was commissioned by the VA to understand experiences and opportunities throughout the nation related to the scheduling of and access to health care. In a very recent publication from October 2015, the IOM summarized their findings and established that inappropriate scheduling practices are a systemic problem across the entire nation and called for an end to arbitrary scheduling standards, for more transparency, more accountability, and for more attention to be paid to the “corrosive culture” that led to the manipulation of data in the system (1). The report also concludes that opportunities exist to implement enhanced practices and strategies. Appropriate Access To Care Within 48 Hours has been identified as one of the top priorities of the Spectrum Health System. To measure access, Spectrum Health uses ‘third next available appointment’ which is the average length of time in days between the day a patient makes a request for an appointment and the third available appointment. Many service lines have prolonged wait times across the Spectrum Health System and, like the VA system, there is tremendous opportunity for improvement. The Cardiology Department of Cardiovascular Services is one of the...
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...GI and Diabetes Exam Study Guide Tube Feeding – (enteral nutrition) refers to the administration of a nutritional balanced liquefied food or formula through a tube inserted into the stomach, duodenum, jejunum. It is used to provide nutrients via the GI tract either alone or as a supplement to oral or parenteral nutrition. - Nasogastric (NG) Tube – is most commonly used for short-term feeding problems. Other means of feeding are; esophagostomy, gastrostomy or jejunostomy. Transpyloric tube placement or placement into the jejunum is used when physiologic condition warrant feeding the pt below the pyloric sphincter. Special Indications – anorexia, orofacial fractures, head and neck cancer, neurologic or psychiatric conditions that prevent oral intake, extensive burns and those who are receiving chemotherapy or radiation therapy. Procedure for tube feeding 1. Patient position – 30-45 degrees position. Head remain elevated for 30-60 mins 2. Patency of tube – Tube should be irrigated with water before and after each feeing to ensure patency. 3. Tube Position – Placement of tube is checked before each feeing or every 8 hours with continuous feeings. Checking methods; aspiration and pH. 4. Formula 5. Administration of feeding – feeing are given either by gravity drip method or by feeding pump. 6. General Nursing Considerations – daily weight, accurate I’s and O’s. Blood glucose check. Complication Related To tube and feeding - Vomiting and or Aspiration -...
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